REF-1072 · James et al., 2013 · Journal of Foot and Ankle Research, · Paper · PubMed

Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review

Nine low-quality studies, no meta-analysis possible; limited evidence that orthoses gave more short-term pain relief than heel raises, and limited evidence overall for heel raises and orthoses in growth-related heel pain

B+moderate evidenceMeasured on non-to trained athletesWritten before October 2026, being re-checked

Calcaneal apophysitis (Sever's disease) typically affects children aged between 8-15 years. Taping, heel lifts and orthoses are accepted conservative treatments, yet very little high-quality research has tested them. This systematic review assessed treatments for the condition by two outcomes: pain reduction and whether children stayed physically active. Abstract only was read.

Protocol

Two reviewers searched nine databases from inception to May 2012 (heel pain, children, adolescent, calcaneal apophysitis, Sever's disease, treatment, management; full-text publications, human studies).
Included: systematic reviews, randomised controlled trials, case series and case studies; reference lists of selected articles were also examined.
Methodology, quality and risk of bias assessed with the PEDro scale.

Key Results

The search found nine articles: three clinical trials with randomisation, two case reports, two case series and two retrospective case reviews.
Effect size calculations and a meta-analysis could not be completed because of the limited data reported.
Numerous treatment options were reported, but few were examined against a control or alternative treatment in well-designed trials.
On limited evidence, orthoses relieved pain better than heel raises in the short term; the authors caution that the studies had methodological problems and limited follow-up.
Conclusion: limited evidence supports heel raises and orthoses for children with heel pain related to calcaneal apophysitis; higher-quality research with larger samples and validated pain and function measures is needed.

Practical Application

"My child's heel hurts when they run or jump — is it a growth thing, and what fixes it?" A systematic review of treatments for growth-plate heel pain (calcaneal apophysitis, usually aged 8-15 years) found only nine weak studies (James 2013, B+): orthoses gave more short-term pain relief than heel raises in the limited evidence, and no treatment is well established. The assistant does not name the condition for a particular child; heel pain in a growing child goes to a parent and a clinician.
The review's outcomes were pain and keeping the child physically active — the aim is not to stop all activity, but the assistant does not set that plan.
Not from this paper; the base's own practice: growth-site pain in a teenage rider goes to a parent and a clinician and the load that hurts is swapped rather than pushed through (SYNTH-81, SYNTH-73); weekly organised hours and early specialisation as overuse risks are REF-602.

Limitations

Only nine studies, most uncontrolled (case series, retrospective reviews, case reports); no effect sizes or pooled estimates.
Methodological problems and limited follow-up in the included studies, as the authors state.
Children with heel pain in general, not athletes or cyclists. Inference, not tested here: cycling loads the heel far less than running and jumping, so transfer to a young rider is weak.
The search ended in May 2012; later trials are not included.
Abstract only was read; nothing from the full text is used.
How this entry was checked and changed
Why this level

graded below the A- of a systematic review of small trials because only three of the nine included articles were randomised trials, the rest case series, retrospective case reviews and case reports, and no pooling was possible